A 60-year-old man was admitted to New York Presbyterian Hospital, NewYork, in acute distress and died within hours after admission. Three yearsbefore he was admitted, a 15 × 12 × 3.6-mm choroidal melanomawas diagnosed and treated with a radioactive iodine plaque.

Because there was continued tumor growth, enucleation was performed9 months later. The tumor was a spindle B melanoma with extension along avortex vein reaching the juxtapapillary episclera. Three years later, thepatient developed liver failure, metabolic acidosis, acute respiratory failure,and shock, and he died. At autopsy, metastases were found in the liver (Figure 1 and Figure 2), gallbladder mucosa, pericardium (Figure 3) and endocardium (Figure4), esophageal mucosa, stomach, small-bowel mucosa (Figure 5), mediastinal lymph nodes, pancreas, thyroid, mesentaryof the large and small bowels, bladder mucosa, both adrenal glands, both kidneys,pleural surface and parenchyma of the lungs, and testes.